The next time you see your cardiologist or internist, what would happen if you took out your smartphone or a digital recorder and said you'd like to record your appointment?
The doctor might be startled, might bridle, might have visions of a supposedly confidential discussion showing up on YouTube — or in a malpractice lawyer's files.
Or the doctor might think more like Dr. James Ryan, a family practitioner in Ludington, Mich.
With his patients' approval, Dr. Ryan routinely records appointments, then uploads the audio to a secure web platform so that patients can listen whenever they need to recall what they discussed with him. They can give family members access to the recordings as well.
Sheri Piper, who has seen Dr. Ryan almost monthly for a host of medical problems — gout, high blood pressure, hypothyroidism, anxiety and depression — has come to rely on this system.
"As aging continues, it's harder to not be overwhelmed by what you hear in a doctor's office," said Ms. Piper, 63, a retired administrative assistant.
An extended round of hospitalizations and operations in 2013 affected her memory, she said, so "you can tell me something today and I won't remember tomorrow."
Thus, last month, straining to recall what Dr. Ryan had said about how often to take allopurinol for gout, she turned to the recording (annotated so that patients can easily locate specific topics of conversation) for clarification.
More ...
https://www.nytimes.com/2017/08/18/health/recording-your-doctors-appointment.html
Saturday, August 19, 2017
Thursday, August 17, 2017
A Start-Up Suggests a Fix to the Health Care Morass - The New York Times
WINFIELD, Kan. — If you watched the drama in Washington last month, you may have come away with the impression that the American health care system is a hopeless mess.
In Congress, a doomed plan to repeal the Affordable Care Act, President Obama's health care law, has turned into a precarious effort to rescue it. Meanwhile, President Trump is still threatening to mortally wound the law — which he insists, falsely, is collapsing anyway — while his administration is undermining its being carried out.
So it is surprising that across the continent from Washington, investors and technology entrepreneurs in Silicon Valley see the American health care system as the next great market for reform.
Some of their interest is because of advances in technology like smartphones, wearable health devices (like smart watches), artificial intelligence, and genetic testing and sequencing. There is a regulatory angle: The Affordable Care Act added tens of millions of people to the health care market, and the law created several incentives for start-ups to change how health care is provided. The most prominent of these is Oscar, a start-up co-founded by Joshua Kushner (the younger brother of Mr. Trump's son-in-law, Jared Kushner), which has found ways to mine health care data to create a better health insurance service.
But perhaps the most interesting and potentially groundbreaking company created in connection with the Affordable Care Act is Aledade, a start-up founded in 2014 by Farzad Mostashari, a doctor and technologist who was the national coordinator for health information technology at the Department of Health and Human Services in the Obama administration.
More ...
https://www.nytimes.com/2017/08/16/technology/a-start-up-suggests-a-fix-to-the-health-care-morass.html?
In Congress, a doomed plan to repeal the Affordable Care Act, President Obama's health care law, has turned into a precarious effort to rescue it. Meanwhile, President Trump is still threatening to mortally wound the law — which he insists, falsely, is collapsing anyway — while his administration is undermining its being carried out.
So it is surprising that across the continent from Washington, investors and technology entrepreneurs in Silicon Valley see the American health care system as the next great market for reform.
Some of their interest is because of advances in technology like smartphones, wearable health devices (like smart watches), artificial intelligence, and genetic testing and sequencing. There is a regulatory angle: The Affordable Care Act added tens of millions of people to the health care market, and the law created several incentives for start-ups to change how health care is provided. The most prominent of these is Oscar, a start-up co-founded by Joshua Kushner (the younger brother of Mr. Trump's son-in-law, Jared Kushner), which has found ways to mine health care data to create a better health insurance service.
But perhaps the most interesting and potentially groundbreaking company created in connection with the Affordable Care Act is Aledade, a start-up founded in 2014 by Farzad Mostashari, a doctor and technologist who was the national coordinator for health information technology at the Department of Health and Human Services in the Obama administration.
More ...
https://www.nytimes.com/2017/08/16/technology/a-start-up-suggests-a-fix-to-the-health-care-morass.html?
Wednesday, August 16, 2017
Teen Drug Overdoses Doubled From 1999 to 2015, CDC Reveals - NBC News
From 1999 to 2015, while America was grappling with wars in Iraq and Afghanistan, and the worst economic crisis since the Depression, another tragedy quietly unfolded — the death rate of teenagers overdosing on drugs more than doubled.
In 2015 alone, there were 772 drug overdose deaths for adolescents ages 15 through 19 and they died at a rate of 3.7 per 100,000, according to figures newly released Wednesday from the federal Centers for Disease Control and Prevention.
By contrast, the death rate was 1.6 per 100,000 in 1999.
"For both male and female adolescents, the majority of drug overdose deaths in 2015 were unintentional," the CDC report states.
And the chief culprits that year were the same drugs that the National Institute on Drug Abuse say killed a total 35,000 Americans of all ages across the country — opiods, specifically heroin.
"Drug deaths are rising very rapidly for this group (although not as fast as at slightly older ages) and opioid analgesics and particularly heroin and fentanyl are the most important contributors," Dr. Christopher Ruhm, author of a recent University of Virginia study which found the national overdose crisis may be even worse than reported, wrote in an email to NBC News.
Ruhm said he expects the death toll for 15- to 19-year-olds will likely be higher after the CDC compiles its figures for 2016 and 2017.
"Not, primarily, because of opioid analgesics but rather because of rapid growth in deaths due to heroin and (often unintentionally) fentanyl use," he wrote. "Prescription opioids have played a role in all of this earlier, particularly in establishing patterns that led to increased heroin use."
More ...
http://www.nbcnews.com/storyline/americas-heroin-epidemic/teen-drug-overdoses-doubled-1999-2015-cdc-reveals-n793006
In 2015 alone, there were 772 drug overdose deaths for adolescents ages 15 through 19 and they died at a rate of 3.7 per 100,000, according to figures newly released Wednesday from the federal Centers for Disease Control and Prevention.
By contrast, the death rate was 1.6 per 100,000 in 1999.
"For both male and female adolescents, the majority of drug overdose deaths in 2015 were unintentional," the CDC report states.
And the chief culprits that year were the same drugs that the National Institute on Drug Abuse say killed a total 35,000 Americans of all ages across the country — opiods, specifically heroin.
"Drug deaths are rising very rapidly for this group (although not as fast as at slightly older ages) and opioid analgesics and particularly heroin and fentanyl are the most important contributors," Dr. Christopher Ruhm, author of a recent University of Virginia study which found the national overdose crisis may be even worse than reported, wrote in an email to NBC News.
Ruhm said he expects the death toll for 15- to 19-year-olds will likely be higher after the CDC compiles its figures for 2016 and 2017.
"Not, primarily, because of opioid analgesics but rather because of rapid growth in deaths due to heroin and (often unintentionally) fentanyl use," he wrote. "Prescription opioids have played a role in all of this earlier, particularly in establishing patterns that led to increased heroin use."
More ...
http://www.nbcnews.com/storyline/americas-heroin-epidemic/teen-drug-overdoses-doubled-1999-2015-cdc-reveals-n793006
10 Things My Chronic Illness Taught My Children - The New York Times
My children have a mother with a chronic illness. They live with my rheumatoid arthritis just as much as I do. I was given my diagnosis when all three of them were young, and since then I've spent a lot of time worrying about what the daily uncertainty of my condition would mean to them, and whether it would affect their development.
They are all teenagers now, one getting ready for college, and I can attest that my illness has indeed affected them. Here's how.
More ...
https://www.nytimes.com/2017/08/16/opinion/chronic-rheumatoid-arthritis-children.html?
They are all teenagers now, one getting ready for college, and I can attest that my illness has indeed affected them. Here's how.
More ...
https://www.nytimes.com/2017/08/16/opinion/chronic-rheumatoid-arthritis-children.html?
Monday, August 14, 2017
IBM Watson Makes a Treatment Plan for Brain-Cancer Patient in 10 Minutes; Doctors Take 160 Hours - IEEE Spectrum
A new study, in which IBM Watson took just 10 minutes to analyze a brain-cancer patient's genome and suggest a treatment plan, demonstrates the potential of artificially intelligent medicine to improve patient care. But although human experts took 160 hours to make a comparable plan, the study's results weren't a total victory of machine over humans.
The patient in question was a 76-year-old man who went to his doctor complaining of a headache and difficulty walking. A brain scan revealed a nasty glioblastoma tumor, which surgeons quickly operated on; the man then got three weeks of radiation therapy and started on a long course of chemotherapy. Despite the best care, he was dead within a year. While both Watson and the doctors analyzed the patient's genome to suggest a treatment plan, by the time tissue samples from his surgery had been sequenced the patient had declined too far.
IBM has been outfitting Watson, its "cognitive computing" platform, to tackle multiple challenges in health care, including an effort to speed up drug discovery and several ways to help doctors with patient care. In this study, a collaboration with the New York Genome Center (NYGC), researchers employed a beta version of IBM Watson for Genomics.
IBM Watson's key feature is its natural-language-processing abilities. This means Watson for Genomics can go through the 23 million journal articles currently in the medical literature, government listings of clinical trials, and other existing data sources without requiring someone to reformat the information and make it digestible. Other Watson initiatives have also given the system access to patients' electronic health records, but those records weren't included in this study.
More ...
http://spectrum.ieee.org/the-human-os/biomedical/diagnostics/ibm-watson-makes-treatment-plan-for-brain-cancer-patient-in-10-minutes-doctors-take-160-hours
The patient in question was a 76-year-old man who went to his doctor complaining of a headache and difficulty walking. A brain scan revealed a nasty glioblastoma tumor, which surgeons quickly operated on; the man then got three weeks of radiation therapy and started on a long course of chemotherapy. Despite the best care, he was dead within a year. While both Watson and the doctors analyzed the patient's genome to suggest a treatment plan, by the time tissue samples from his surgery had been sequenced the patient had declined too far.
IBM has been outfitting Watson, its "cognitive computing" platform, to tackle multiple challenges in health care, including an effort to speed up drug discovery and several ways to help doctors with patient care. In this study, a collaboration with the New York Genome Center (NYGC), researchers employed a beta version of IBM Watson for Genomics.
IBM Watson's key feature is its natural-language-processing abilities. This means Watson for Genomics can go through the 23 million journal articles currently in the medical literature, government listings of clinical trials, and other existing data sources without requiring someone to reformat the information and make it digestible. Other Watson initiatives have also given the system access to patients' electronic health records, but those records weren't included in this study.
More ...
http://spectrum.ieee.org/the-human-os/biomedical/diagnostics/ibm-watson-makes-treatment-plan-for-brain-cancer-patient-in-10-minutes-doctors-take-160-hours
Sunday, August 13, 2017
Forever Yesterday: Peering Inside My Mom’s Fading Mind
Every time I talk to my mom on the phone, just as I'm getting ready to say goodbye, she slips in an abrupt update about her parents — my grandparents. Sometimes they're in Switzerland. Sometimes they're in Loma, Montana. Sometimes they've gotten "mixed up with bad people." Sometimes they've completely disappeared or died mysteriously. Sometimes it sounds like a government conspiracy — a murder plot. At first, I didn't know what to say in return. I'd ask how they died or what they were doing in Switzerland. In more recent conversations, I tried to place her back in reality. I'd say, "Mom, your parents have been dead for forty years." I'd ask her how old they were and she would say 60, 70, or 75. She's not sure. She says that all the time: I'm not sure. "How old are you?" I ask, and she laughs and says, "Oh, I think I'm about 25." Once she said she was 18. She's actually 88 years old.
For about two years now, my mother has been fighting with Alzheimer's and the dementia that comes from that disease. She's had years of struggle with diabetes and epilepsy — but her mental condition was always sharp. A lifelong democrat and the mother of six, Patsy loved sewing, making quilts, reading mystery novels, and watching Seattle Mariners baseball while enjoying a Pepsi (never Coke). I am her youngest son.
More ...
https://longreads.com/2017/08/11/forever-yesterday-peering-inside-my-moms-fading-mind/?
For about two years now, my mother has been fighting with Alzheimer's and the dementia that comes from that disease. She's had years of struggle with diabetes and epilepsy — but her mental condition was always sharp. A lifelong democrat and the mother of six, Patsy loved sewing, making quilts, reading mystery novels, and watching Seattle Mariners baseball while enjoying a Pepsi (never Coke). I am her youngest son.
More ...
https://longreads.com/2017/08/11/forever-yesterday-peering-inside-my-moms-fading-mind/?
The Symptoms of Dying - The New York Times
You and I, one day we'll die from the same thing. We'll call it different names: cancer, diabetes, heart failure, stroke.
One organ will fail, then another. Or maybe all at once. We'll become more similar to each other than to people who continue living with your original diagnosis or mine.
Dying has its own biology and symptoms. It's a diagnosis in itself. While the weeks and days leading up to death can vary from person to person, the hours before death are similar across the vast majority of human afflictions.
Some symptoms, like the death rattle, air hunger and terminal agitation, appear agonizing, but aren't usually uncomfortable for the dying person. They are well-treated with medications. With hospice availability increasing worldwide, it is rare to die in pain.
While few of us will experience all the symptoms of dying, most of us will have at least one, if not more. This is what to expect.
More ...
https://www.nytimes.com/2017/06/20/well/live/the-symptoms-of-dying.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
One organ will fail, then another. Or maybe all at once. We'll become more similar to each other than to people who continue living with your original diagnosis or mine.
Dying has its own biology and symptoms. It's a diagnosis in itself. While the weeks and days leading up to death can vary from person to person, the hours before death are similar across the vast majority of human afflictions.
Some symptoms, like the death rattle, air hunger and terminal agitation, appear agonizing, but aren't usually uncomfortable for the dying person. They are well-treated with medications. With hospice availability increasing worldwide, it is rare to die in pain.
While few of us will experience all the symptoms of dying, most of us will have at least one, if not more. This is what to expect.
More ...
https://www.nytimes.com/2017/06/20/well/live/the-symptoms-of-dying.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
Should I Help My Patients Die? - The New York Times
I was leafing through a patient's chart last year when a colleague tapped me on the shoulder. "I have a patient who is asking about the End of Life Option Act," he said in a low voice. "Can we even do that here?"
I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.) Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.
That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn't.
I could see my own discomfort mirrored in his face. "Can you help us with it?" he asked me. "Of course," I said. Then I felt my stomach lurch.
California's law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.
More ...
https://www.nytimes.com/2017/08/05/opinion/sunday/dying-doctors-palliative-medicine.html?
I practice both critical and palliative care medicine at a public hospital in Oakland. In June 2016, our state became the fourth in the nation to allow medical aid in dying for patients suffering from terminal illness. Oregon was the pioneer 20 years ago. Washington and Vermont followed suit more recently. (Colorado voters passed a similar law in November.) Now, five months after the law took effect here in California, I was facing my first request for assistance to shorten the life of a patient.
That week, I was the attending physician on the palliative care service. Since palliative care medicine focuses on the treatment of all forms of suffering in serious illness, my colleague assumed that I would know what to do with this request. I didn't.
I could see my own discomfort mirrored in his face. "Can you help us with it?" he asked me. "Of course," I said. Then I felt my stomach lurch.
California's law permits physicians to prescribe a lethal cocktail to patients who request it and meet certain criteria: They must be adults expected to die within six months who are able to self-administer the drug and retain the mental capacity to make a decision like this.
More ...
https://www.nytimes.com/2017/08/05/opinion/sunday/dying-doctors-palliative-medicine.html?
Surgery Is One Hell Of A Placebo | FiveThirtyEight
The guy's desperate. The pain in his knee has made it impossible to play basketball or walk down stairs. In search of a cure, he makes a journey to a healing place, where he'll undergo a fasting rite, don ceremonial garb, ingest mind-altering substances and be anointed with liquids before a masked healer takes him through a physical ritual intended to vanquish his pain.
Seen through different eyes, the process of modern surgery may look more more spiritual than scientific, said orthopedic surgeon Stuart Green, a professor at the University of California, Irvine. Our hypothetical patient is undergoing arthroscopic knee surgery, and the rituals he'll participate in — fasting, wearing a hospital gown, undergoing anesthesia, having his surgical site prepared with an iodine solution, and giving himself over to a masked surgeon — foster an expectation that the procedure will provide relief, Green said.
These expectations matter, and we know they matter because of a bizarre research technique called sham surgery. In these fake operations, patients are led to believe that they are having a real surgical procedure — they're taken through all the regular pre- and post- surgical rituals, from fasting to anesthesia to incisions made in their skin to look like the genuine operation occurred — but the doctor does not actually perform the surgery. If the patient is awake during the "procedure," the doctor mimics the sounds and sensations of the true surgery, and the patient may be shown a video of someone else's procedure as if it were his own.
Sham surgeries may sound unethical, but they're done with participants' consent and in pursuit of an important question: Does the surgical procedure under consideration really work? In a surprising number of cases, the answer is no.
More ...
https://fivethirtyeight.com/features/surgery-is-one-hell-of-a-placebo/?
Seen through different eyes, the process of modern surgery may look more more spiritual than scientific, said orthopedic surgeon Stuart Green, a professor at the University of California, Irvine. Our hypothetical patient is undergoing arthroscopic knee surgery, and the rituals he'll participate in — fasting, wearing a hospital gown, undergoing anesthesia, having his surgical site prepared with an iodine solution, and giving himself over to a masked surgeon — foster an expectation that the procedure will provide relief, Green said.
These expectations matter, and we know they matter because of a bizarre research technique called sham surgery. In these fake operations, patients are led to believe that they are having a real surgical procedure — they're taken through all the regular pre- and post- surgical rituals, from fasting to anesthesia to incisions made in their skin to look like the genuine operation occurred — but the doctor does not actually perform the surgery. If the patient is awake during the "procedure," the doctor mimics the sounds and sensations of the true surgery, and the patient may be shown a video of someone else's procedure as if it were his own.
Sham surgeries may sound unethical, but they're done with participants' consent and in pursuit of an important question: Does the surgical procedure under consideration really work? In a surprising number of cases, the answer is no.
More ...
https://fivethirtyeight.com/features/surgery-is-one-hell-of-a-placebo/?
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